Good policy requires good data. It's time to open the door to research on US gun violence

The Dickey Amendment that prohibits the Centers for Disease Control and Prevention (CDC) from using US federal funds to advocate or promote gun control is confusing so it is no surprise that many people in Congress are trying to repeal it with the intent to fund gun violence prevention research.

The amendment emerged in 1996 in the heat of a battle between two formidable forces: the NRA-led members of Congress who wanted to protect and enlarge gun rights, and those who wanted more gun control.

This battle was personified in two formidable foes: Representative Jay Dickey, a Republican born-again Christian conservative, life-time NRA member, from rural Arkansas, and me, a liberal Jewish physician from the Northeast who was trying to establish a scientific research program to address gun violence from a public health perspective.

We started our work on gun violence at the CDC with the idea that if we could use research to answer four key questions about gun violence we could save as many lives as had been saved when the government initiated a research program to stop the epidemic of young lives being lost to motor vehicle crashes in the 1960s. 

That initiative – the National Highway Traffic Safety Administration – appropriated $200 million a year for research. It led to safer cars with front-end crash protection, side-impact protection, seat belts, and multiple airbags. It led to safer roads and safer drivers – all of which together saved more than 350,000 lives.

And it was all done without banning cars.

To achieve similar results with firearm injuries, the four questions we needed to ask were:

• What’s the problem?
  Who, what, where, and how are people being shot, with what types of weapons; what is the relationship between shooter and victim; and are these shootings increasing or decreasing?

• What are the causes?
  What is the role of gangs, alcohol and drugs, mental illness, domestic violence, and easy access to firearms?  What’s the impact on medical injuries from high capacity magazines and high velocity ammunition? What are the combinations of these factors that lead someone to pull the trigger?  Why do more males than females use guns to kill themselves? Is there a connection between access to guns and depression or impulsivity?

• What works to prevent these injuries?
  Does arming teachers or putting armed guards in all schools save lives or result in more children being injured?  Does making it easier for people to carry concealed weapons make us safer or result in more shootings? Do waiting periods prevent suicides?

• How do you do it?
  How do you scale up interventions that work and translate them into policy and legislation?

The NRA leadership adopted a strategy of zero tolerance.  They told their members that it was all or none: either they could keep their guns or do the research but they could not have both.  They wanted to stop this gun violence prevention research by abolishing the entire injury center at CDC.

The Dickey Amendment was a last minute compromise between the gun rights advocates and the gun control advocates that evolved in the House Appropriations committee in 1996.  It stated: "The bill contains a limitation to prohibit the National Center for Injury Prevention and Control at the Centers for Disease Control from engaging in any activities to advocate or promote gun control.

"The CDC may need to collect data on the incidence of gun related violence, but the Committee does not believe that it is the role of the CDC to advocate or promote policies to advance gun control initiatives, or to discourage responsible private gun ownership.

"The Committee expects research in this area to be objective and grants to be awarded through an impartial peer review process."

Technically speaking, the amendment prohibited lobbying for specific gun control legislation without prohibiting research.  But it was used as a shot across the bow to research scientists and federal bureaucrats warning them that if they undertook research in the area of gun violence prevention, Congress could make their lives miserable by forcing them to spend weeks to months answering congressional inquiries sent to the secretary of The Department of Health and Human Services (HSS) or the Director of the CDC accusing them of using government funds to promote or advocate gun control.  

A second shot across the bow was the zeroing out by Congress of the $2.6 million that the CDC had been using to support its gun violence research.  A third shot came when the Director of CDC fired me, the person most closely identified with the CDC’s gun violence research. As a result the gun violence prevention research that the CDC did fell off by more than 90 per cent.

Since then, there has been some very productive research by a small number of academic researchers and we do certainly know some answers to the questions What’s the Problem? and What are the Causes?  But we are still ill-equipped to answer the most critical question of all: What works to prevent these injuries?  

When the Federally sponsored Task Force for Community Preventive Services reviewed the state of our knowledge about what works, they found that for every one of the principle ways to reduce gun violence – including limiting access to certain types of weapons, making it easier to carry concealed weapons, gun registration and licensing of gun owners – we could not say what works. For every one of these interventions we lacked sufficient data and evidence.

Members of Congress on both sides of the aisle appreciate having the evidence they need to make sound policy and the lack of evidence has hindered good policy making.

After the House appropriations committee hearing where Congressman Dickey effectively ambushed the Director of the CDC and me, I was told by my CDC handlers to be sure that I never, ever talk to Mr Dickey because I would only make things worse.  It would be like throwing a lighted match on gasoline.

Soon after that, however, we did start talking – at his invitation.  And over the years we talked more and more. We came to know each other, to trust each other, to talk to each other and learn from each other.  I taught him about the public health approach and the value of science in solving seemingly unsolvable problems.

He taught me that our research needed to have two objectives, not just one. We needed to find interventions that would both reduce gun violence and protect the rights of law-abiding gun owners.  And we needed to make this clear to both sides. It was not, as the NRA leadership would have had us believe, a question of being either for reducing gun violence or protecting gun rights. Through research we could find things that would do both.  

Just like in cancer research where we need to find new therapies that will both stop the tumor and protect the patient’s vital organs. In fact, research is the only way we make progress in fighting cancer, and it has produced immunotherapies which can both stop the cancer and keep the patient alive.  

Jay Dickey and I started out as near-mortal enemies and we became wonderful friends.  The Dickey amendment started out as a threat to stop gun violence prevention research but it has become the key to restarting it.

American society is polarised when it comes to guns.  The two sides don’t want to hear each other or learn from each other.  They want to beat the other down. When we came together Jay and I realised that to restore the funding we would need bi-partisan support and we understood that science was the way to build a post-partisan common ground. Once we had the results, research could tell legislators what works, what is both safe and effective.

In the absence of knowledge and in this environment, common sense is not enough because what each side puts forth as common sense, the other sides calls lies and propaganda.  Now the Dickey Amendment provides cover to legislators on both sides who are afraid of the NRA because it assures them that any money appropriated to the CDC for gun violence prevention research will be used for research, and not to lobby for gun control.

A small appropriation of $20 million - one tenth the amount that was used to start federal research on motor vehicle injury prevention 50 years ago - will be enough to get this life-saving research going.

The cost of standing in opposite corners and approaching the issue as the ultimate fighting championship, is that our children will continue to be killed, and our mothers and fathers, sisters and brothers will shoot themselves or be shot by others.  

No one wants that, not gun control advocates or NRA members. We don’t need to continue down this path—there is a clear path to making our homes, our schools and our communities safer.  It’s not the only path but it is one that leads to safety and protecting our second amendment rights.

It would honor Congressman Dickey to know that this research will be born again.

The author, Mark L. Rosenberg , is a physician and public health researcher who is the former president and CEO of the Task Force for Global Health. He previously worked at the CDC where he helped oversee research on gun violence.

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